Emerging infectious disease outbreaks cause significant fear and uncertainty. Psychiatrists can play an important role in supporting the well-being of patients and families, health care personnel, and the general public.
Emerging infectious disease outbreaks, such as COVID-19, cause significant fear and uncertainty. Psychiatrists can play an important role in supporting the well-being of patients and families, health care personnel, and the general public.
Infectious disease outbreaks produce a range of psychological and behavioral effects. Inform patients about common responses, such as insomnia, anxiety, fear of illness, or desire to increase alcohol and tobacco use. Children and adolescents may experience regression, social isolation, or aggressive behaviors, all of which can be misinterpreted as "acting out." Educate patients on ways to reduce overall stress, such as getting adequate sleep, eating regular meals, exercising, staying connected to friends and family, and relaxation techniques. Inform patients when and where to get help if needed.
Recommend patients use trusted sources, such as the Centers for Disease Control and Prevention, to obtain the most updated information on keeping their family safe and healthy, which can decrease distress. Encourage patients to develop a family plan for dealing with outbreaks, which reminds people there are steps they can take to care for themselves. Knowing your work and/or school plans for dealing with COVID-19 also helps reassure people about steps being taken by others to safeguard their health. Recommend patients to limit exposure to outbreak-related traditional and social media; increased media exposure is often associated with higher levels of distress.
Most patients with COVID-19 illness-related concerns will present in primary and emergency settings. Psychiatrists can play an important role in optimizing population mental health by providing interdisciplinary education, consultation, and collaboration to help colleagues more effectively identify outbreak-related distress responses and provide early interventions. Non-infected patients experiencing illness-related distress should have their concerns validated, while also helping them learn ways to more effectively cope. Interventions should serve to enhance feelings of safety, calming, self- and community efficacy, social connectedness, and hope or optimism about the future.
Uncertainty about the future is common and best addressed through practical problem-solving. For instance, Psychiatrists can help people consider alternative social greetings when handshaking is discouraged, or explore technology-based means of connecting for community activities when social distancing measures recommend avoiding large, group gatherings. Encourage families to involve children in problem-solving, which can decrease feelings of distress for kids. Reminding people there are steps they can take to manage through challenges enhances calming, increases self-efficacy, and reduces feelings of helplessness.
Psychiatrists can empower patients, families, and care provider through education about the psychological effects of isolation and quarantine. Short-term effects may include anxiety, anger, fear of infecting others, and frustration, with those who experience longer periods of isolation being more likely to develop posttraumatic stress symptoms or increase substance use. Ensuring quarantined patients have adequate supplies and that they and their families are given comprehensive, ongoing, updated information reduces distress and uncertainty. The use of technology to connect patients with family, friends and their health care team can decrease feelings of isolation.
Psychiatrists should educate health care and community leaders about effective ways to support population mental health during the COVID-19 outbreak. Psychiatrists can provide resources to leaders that help them better understand the psychological and behavioral effects of outbreaks and pandemics, predictable phases of community response, and important principles in preparedness and response. Effective health risk and crisis communication is a critical behavioral health intervention that leaders should use to reduce community distress. In addition, grief leadership helps organizations and communities by acknowledging the difficulties and losses that occur as a result of crisis events, making meaning of the difficulties, and providing a sense of hope about the future.
COVID-19 and other infectious disease outbreaks severely stress health systems and the providers working within them. Routine and ongoing self-care helps providers function more effectively at work and home. Sleeping, eating, hydrating, and taking breaks are important during the work-day. Providing support to peers, finding constructive solutions to work challenges, and staying connected with family and friends can lower overall stress.
About the author
Dr Morganstein is Chair of the American Psychiatric Association Committee on the Psychiatric Dimensions of Disaster.